Skip to main content Accessibility help

Peritoneal dialysis during congenital heart surgery admissions: insights from a large database

  • Rohit S. Loomba (a1), Enrique G. Villarreal (a2) (a3), Ronald A. Bronicki (a2) and Saul Flores (a2)



The management of fluid overload after congenital heart surgery has been limited to diuretics, fluid restriction, and dialysis. This study was conducted to determine the association between peritoneal dialysis and important clinical outcomes in children undergoing congenital heart surgery.


A retrospective review was conducted to identify patients under 18 years of age who underwent congenital heart surgery. The data were obtained over a 16-year period (1997–2012) from the Kids’ Inpatient Database. Data analysed consisted of demographics, diagnoses, type of congenital heart surgery, length of stay, cost of hospitalisation, and mortality. Logistic regression was performed to determine factors associated with peritoneal dialysis.


A total of 46,176 admissions after congenital heart surgery were included in the study. Of those, 181 (0.4%) utilised peritoneal dialysis. The mean age of the peritoneal dialysis group was 7.6 months compared to 39.6 months in those without peritoneal dialysis. The most common CHDs were atrial septal defect (37%), ventricular septal defect (32.6%), and hypoplastic left heart syndrome (18.8%). Univariate analyses demonstrated significantly greater length of stay, cost of admission, and mortality in those with peritoneal dialysis. Regression analyses demonstrated that peritoneal dialysis was independently associated with significant decrease in cost of admission (−$57,500) and significant increase in mortality (odds ratio 1.5).


Peritoneal dialysis appears to be used in specific patient subsets and is independently associated with decreased cost of stay, although it is associated with increased mortality. Further studies are needed to describe risks and benefit of peritoneal dialysis in this population.


Corresponding author

Author for correspondence: E. G. Villarreal, MD, Cardiac Intensive Care Unit, Section of Critical Care and Cardiology, Research Scholar, Texas Children’s Hospital/Baylor College of Medicine, 6651 S. Main St, MCE 1420, Suite E. 1460.31A., Houston, TX77030, USA. Tel: +1 312 282 6935; Fax: +1 832 825 2969. E-mail:;


Hide All
1.Morgan, CJ, Zappitelli, M, Robertson, CM, et al.Risk factors for and outcomes of acute kidney injury in neonates undergoing complex cardiac surgery. J Pediatr 2013; 162: 120127.e121.
2.Milovanovic, V, Bisenic, D, Mimic, B, et al.Reevaluating the importance of modified ultrafiltration in contemporary pediatric cardiac surgery. J Clin Med 2018; 7: 498.
3.Stein, A, de Souza, LV, Belettini, CR, et al.Fluid overload and changes in serum creatinine after cardiac surgery: predictors of mortality and longer intensive care stay. A prospective cohort study. Critical Care 2012; 16: R99.
4.Pradeep, A, Rajagopalam, S, Kolli, HK, et al.High volumes of intravenous fluid during cardiac surgery are associated with increased mortality. HSR Proc Intensive Care Cardiovasc Anesth 2010; 2: 287296.
5.Sutherland, SM, Zappitelli, M, Alexander, SR, et al.Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis 2010; 55: 316325.
6.Kaddourah, A, Basu, RK, Bagshaw, SM, Goldstein, SL. Epidemiology of acute kidney injury in critically ill children and young adults. N Engl J Med 2017; 376: 1120.
7.Selewski, DT, Cornell, TT, Lombel, RM, et al.Weight-based determination of fluid overload status and mortality in pediatric intensive care unit patients requiring continuous renal replacement therapy. Intensive Care Med 2011; 37: 11661173.
8.Barhight, MF, Soranno, D, Faubel, S, Gist, KM. Fluid management with peritoneal dialysis after pediatric cardiac surgery. World J Pediatr Congenit Heart Surg 2018; 9: 696704.
9.Kwiatkowski, DM, Menon, S, Krawczeski, CD, et al.Improved outcomes with peritoneal dialysis catheter placement after cardiopulmonary bypass in infants. J Thorac Cardiovasc Surg 2015; 149: 230236.
10.Kwiatkowski, DM, Goldstein, SL, Cooper, DS, Nelson, DP, Morales, DL, Krawczeski, CD. Peritoneal dialysis vs furosemide for prevention of fluid overload in infants after cardiac surgery: a randomized clinical trial. JAMA Pediatr 2017; 171: 357364.
11.Ozker, E, Saritas, B, Vuran, C, et al.Early initiation of peritoneal dialysis after arterial switch operations in newborn patients. Ren Fail 2013; 35: 204209.
12.Goldstein, SL. Overview of pediatric renal replacement therapy in acute kidney injury. Semin Dial 2009; 22: 180184.
13.Madenci, AL, Stoffan, AP, Rajagopal, SK, et al.Factors associated with survival in patients who undergo peritoneal dialysis catheter placement following cardiac surgery. J Pediatr Surg 2013; 48: 12691276.
14.Wilder, NS, Yu, S, Donohue, JE, Goldberg, CS, Blatt, NB. Fluid overload is associated with late poor outcomes in neonates following cardiac surgery. Pediatr Crit Care Med 2016; 17: 420427.
15.Toda, Y, Sugimoto, K. AKI after pediatric cardiac surgery for congenital heart diseases-recent developments in diagnostic criteria and early diagnosis by biomarkers. J Intensive Care 2017; 5: 49.
16.Chen, Q, Cao, H, Hu, YN, Chen, LW, He, JJ. Use of a simply modified drainage catheter for peritoneal dialysis treatment of acute renal failure associated with cardiac surgery in infants. Medicine (Baltimore) 2014; 93: e77.
17.Bojan, M, Gioanni, S, Vouhe, PR, Journois, D, Pouard, P. Early initiation of peritoneal dialysis in neonates and infants with acute kidney injury following cardiac surgery is associated with a significant decrease in mortality. Kidney Int 2012; 82: 474481.
18.Flores, S, Loomba, RS, Elhoff, JJ, et al.Peritoneal dialysis versus diuretics in children after congenital heart surgery. Ann Thorac Surg 2019; 108: 806812
19.Madenci, AL, Thiagarajan, RR, Stoffan, AP, Emani, SM, Rajagopal, SK, Weldon, CB. Characterizing peritoneal dialysis catheter use in pediatric patients after cardiac surgery. J Thorac Cardiovasc Surg 2013; 146: 334338.
20.Fleming, F, Bohn, D, Edwards, H, et al.Renal replacement therapy after repair of congenital heart disease in children. A comparison of hemofiltration and peritoneal dialysis. J Thorac Cardiovasc Surg 1995; 109: 322331.
21.Giuffre, RM, Tam, KH, Williams, WW, Freedom, RM. Acute renal failure complicating pediatric cardiac surgery: a comparison of survivors and nonsurvivors following acute peritoneal dialysis. Pediatr Cardiol 1992; 13: 208213.
22.Kist-van Holthe tot Echten, JE, Goedvolk, CA, Doornaar, MB, et al.Acute renal insufficiency and renal replacement therapy after pediatric cardiopulmonary bypass surgery. Pediatr Cardiol 2001; 22: 321326.
23.Chan, KL, Ip, P, Chiu, CS, Cheung, YF. Peritoneal dialysis after surgery for congenital heart disease in infants and young children. Ann Thorac Surg 2003; 76: 14431449.
24.Werner, HA, Wensley, DF, Lirenman, DS, LeBlanc, JG. Peritoneal dialysis in children after cardiopulmonary bypass. J Thorac Cardiovasc Surg 1997; 113: 6468; discussion 68–70.
25.Weng, KP, Hsieh, KS, Huang, SH, Lin, CC, Pan, JY. Peritoneal dialysis in treatment of postoperative heart failure after cardiac surgery in infants. Acta Paediatr Taiwan 2004; 45: 8184.
26.Sorof, JM, Stromberg, D, Brewer, ED, Feltes, TF, Fraser, CD Jr.Early initiation of peritoneal dialysis after surgical repair of congenital heart disease. Pediatr Nephrol 1999; 13: 641645.
27.Alkan, T, Akcevin, A, Turkoglu, H, et al.Postoperative prophylactic peritoneal dialysis in neonates and infants after complex congenital cardiac surgery. Asaio J 2006; 52: 693697.
28.O’Brien, SM, Clarke, DR, Jacobs, JP, et al.An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg 2009; 138: 11391153.
29.Redpath Mahon, AC, Richardson, T, Neu, AM, Warady, BA. Factors associated with high-cost hospitalization for peritonitis in children receiving chronic peritoneal dialysis in the United States. Pediatr Nephrol 2019; 34: 10491055.


Peritoneal dialysis during congenital heart surgery admissions: insights from a large database

  • Rohit S. Loomba (a1), Enrique G. Villarreal (a2) (a3), Ronald A. Bronicki (a2) and Saul Flores (a2)


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.